City of Regina Benefits

Life, Health and Dental Benefits

SCHEDULE OF BENEFITS

Date of Issue: 13 March 2017 This booklet contains all amendments which are currently effective under

the Group Benefits Contract held by your employer.

CITY OF REGINA Group Policy Number: 53004 – 002, 003, 004, 005, 006, 007, 008, 016, 017 and 018 Class: All City of Regina Employees with Health, Dental and Life Benefits Eligibility Period: Sections – 002, 003, 004, 005, 006, 007, Coverage commensurate with date of hire. and 017: Section – 008: Dental Benefits Coverage commensurate with completion of 2,069 hours. Life Insurance and Health Benefits Coverage commensurate with date of hire. Section – 016: Following six months of active permanent employment. Section – 018: Coverage commensurate with completion of 1,907 hours. Coverage Change Date: The date your insurance will begin, increase or decrease in response to

a change in status is the actual date on which your approved status changes. Change in status means a change to your employment status, the addition of a benefit or a change to an existing benefit.

Welcome To Your Group Benefit Program Group Policy Effective Date: February 1, 2007 Saskatchewan Blue Cross understands the importance of security, strength and stability in people's lives. Your

Group Benefit Program provides you with the assurance that you, and your family, are financially protected today and

in the future.

This booklet summarizes the important features of your group program; is prepared as information only; and does

not, in itself, constitute an agreement. The exact terms and conditions of your group benefits program are described

in the Group Benefits Contract held by your employer.

The information contained in this booklet is important and we suggest it be kept in a safe place.

SCHEDULE OF BENEFITS

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Underwritten by Saskatchewan Blue Cross SECTIONS – All Sections: All Employees and Their Eligible Dependents EXTENDED HEALTH CARE BENEFITS Deductible: Nil Reimbursement: 100% - Paramedical/Health $300 Maximum for each type of practitioner Practitioners: per person per calendar year - Psychologists: $500 Maximum per person per calendar year - Speech Therapists: $500 Maximum per person per calendar year Overall Maximum: Unlimited unless defined otherwise Coverage Terminates: Upon retirement. PRESCRIPTION DRUG BENEFITS Deductible: A deductible amount equal to the dispensing fee will be charged for each prescription dispensed Pay Direct Drug Card: 80% Until Out of Pocket expenses accumulate to $1,000 per person per calendar year 100% After the Out of Pocket expenses accumulate to $1,000 to a maximum of $10,000 per person per calendar year Coverage Terminates: Upon retirement. HOSPITAL ACCOMMODATION BENEFITS Deductible: Nil Reimbursement: 100% - Private / Semi-Private Maximum: Unlimited unless defined otherwise Coverage Terminates: Upon retirement. OUTSIDE PROVINCE OF RESIDENCE TRAVEL BENEFITS Deductible: Nil Reimbursement: 100% Maximum: $5,000,000 per person per trip Coverage Terminates: Upon retirement.

SCHEDULE OF BENEFITS

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Underwritten by Saskatchewan Blue Cross SECTIONS – All Sections: All Employees and Their Eligible Dependents VISION CARE BENEFITS Deductible: Nil Reimbursement: 100% Maximum: $150 per person every two calendar years (every calendar

year for eligible dependent children) Coverage Terminates: Upon retirement. DENTAL CARE BENEFITS Dental Fee Schedule: Current General Practitioners' Dental Fee Guide in the

province in which the services were rendered, with the exception of Employees incurring claims in Alberta in which the current Alberta Blue Cross Usual and Customary General Practitioners' Dental Fee Schedule applies.

Deductible: Nil Reimbursement: Preventive Dental Services 80% Minor Restorative Dental Services 80% Major Dental Services 60% Combined Overall Maximum: $1,500 per person per calendar year Coverage Terminates: Upon retirement. ORTHODONTIC: (Eligible Dependent Children over age 6 and under age 21) Deductible: Nil Reimbursement: 50% Lifetime Maximum: $2,000 per person Coverage Terminates: Upon retirement.

SCHEDULE OF BENEFITS

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Underwritten by Blue Cross Life Insurance Company of Canada GROUP LIFE INSURANCE SECTIONS – 002, 003, 004, 005, 006, 007, and 008: Option 1: All Employees: 2.5 times annual earnings (all amounts of insurance are

rounded up to the next higher $1,000 amount) Maximum Benefit: $450,000 Non-Evidence Limit: $450,000 Reduction: 50% at age 65 Coverage Terminates: At the earlier of retirement or age 70. Option 2: All Employees: Maximum Benefit: $60,000 Non-Evidence Limit: $60,000 Reduction: 50% at age 65 Coverage Terminates: At the earlier of retirement or age 70. SECTION –016: Option 1: All Employees: 2.5 times annual earnings (all amounts of insurance are

rounded up to the next higher $1,000 amount) Maximum Benefit: $450,000 Non-Evidence Limit: $450,000 Reduction: 50% at age 65 Coverage Terminates: At the end of the term or age 70. Option 2: All Employees: Maximum Benefit: $60,000 Non-Evidence Limit: $60,000 Reduction: 50% at age 65 Coverage Terminates: At the end of the term or age 70.

SCHEDULE OF BENEFITS

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Underwritten by Blue Cross Life Insurance Company of Canada GROUP LIFE INSURANCE SECTION –017: Option 1: All Employees: 2.5 times annual earnings (all amounts of insurance are

rounded up to the next higher $1,000 amount) Maximum Benefit: $450,000 Non-Evidence Limit: $450,000 Coverage Terminates: At the earlier of retirement or age 65. Option 2: All Employees: Maximum Benefit: $60,000 Non-Evidence Limit: $60,000 Coverage Terminates: At the earlier of retirement or age 65. SECTION –018: Option 3 is for Regina CUPE, Local 7 Casual Employees who work between 1,907 – 9,999 hours. Option 3: All Employees: Maximum Benefit: $15,000 Non-Evidence Limit: $15,000 Reduction: 50% at age 65 Coverage Terminates: At the earlier of retirement or age 70. Option 4 is for Regina CUPE, Local 7 Casual Employees who work greater than 10,000 hours. Option 4: All Employees: Maximum Benefit: $40,000 Non-Evidence Limit: $40,000 Reduction: 50% at age 65 Coverage Terminates: At the earlier of retirement or age 70.

SCHEDULE OF BENEFITS

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DEPENDENT LIFE INSURANCE SECTIONS – 002, 003, 004, 005, 006, 007 and 008: ** All Eligible Dependents Spouse: $25,000 of All Employees: Each Child: $12,500 Coverage Terminates: At the earlier of retirement or age 65. ** Other Dependent Life Insurance amounts in force prior to February 1, 2007 may be continued for some employees.

SCHEDULE OF BENEFITS

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Underwritten by Blue Cross Life Insurance Company of Canada OPTIONAL GROUP LIFE INSURANCE SECTIONS – All Sections: All Employees who have Basic Group Life Insurance:

Insured Benefit Formula Non-Evidence Limit

Employee and/or Spouse Coverage is provided in units of $10,000 to a maximum of $250,000 per employee and/or spouse. The combined Basic Group Life benefit plus the Optional Life benefit cannot exceed $700,000.

$30,000

Dependent Child Coverage is provided in units of $5,000 to a maximum of $15,000 per dependent child.

$10,000

Termination: Employee: Ceases at the earlier of the employee's retirement or the

employee's attainment of age 65. Spouse: Ceases at the earlier of the employee's retirement or the

employee's attainment of age 65 or the spouse’s attainment of age 65 or when no longer an eligible spouse.

Dependent Child: Ceases at the earlier of the employee's retirement or the employee's attainment of age 65 or when no longer an eligible dependent.

Please refer to the appropriate page in this booklet for a more detailed benefit description. *Please refer to the Group Contract, as the non-evidence limits are subject to change each year on the Group's anniversary date. All benefits described in this booklet are available to employees of the Group, subject to the application by the employee and underwriting approval.

GENERAL INFORMATION

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ELIGIBLE EMPLOYEES You are eligible to enroll for benefits if you are a permanent employee actively at work and have completed the eligibility period as show in the Schedule of Benefits. Employees may elect coverage by completing an application within 31 days of becoming eligible. Coverage is effective on the later of the date of eligibility or the date that application is made for group benefits provided you are actively at work on the effective date. If not actively at work when you would normally have become eligible, your coverage will commence when you return to work on a permanent basis. ELIGIBILITY If you do not apply for coverage within one month after you become eligible or if you change the status of your coverage from single to family, your Dental Care Benefits will be subject to the following restrictions:

- Preventive and Minor Restorative Benefits are limited to a maximum of $100 during the first 12 months from the date of application. - A combined maximum of $100 for Major Restorative and Orthodontic Benefits will apply during the first 12

months from the date of application. ELIGIBLE DEPENDENTS Dependents are defined as your legal or former spouse (as described below) and unmarried, unemployed dependent children including natural, adopted, step-children or any unmarried child for whom the employee or the covered spouse has been appointed guardian for all purposes by a court of competent jurisdiction. Children of a common-law spouse may be covered if they are living with you. The term "spouse" means the person who is legally married to you, or has continuously resided with you for not less than 12 months having been represented as members of a conjugal relationship. At no time will Saskatchewan Blue Cross provide coverage for more than one spouse. The employee requesting coverage for a "common-law" spouse must give written notice to Saskatchewan Blue Cross. Unless such written request is made, the person legally married to the employee shall be considered to be the covered spouse. Discontinuance of cohabitation with the employee shall terminate coverage of the "common-law" spouse. A former spouse means a divorced or ex-common-law spouse of the Member for whom insurance protection for some of the benefits available under the employer’s program is mandated by a court order. A change from a common-law to a legal spouse is valid only when the legal spouse is living with the Member. A change from a former spouse to a legal or common-law spouse will not be allowed unless the provision in a court order by which the former spouse qualified for coverage is no longer in effect. Dependent children are eligible for benefits if they are less than 21 years of age or; if 21 years of age but less than 25 years of age, they must be attending an accredited educational institution, college, or university on a full-time basis and are unemployed (working less than 30 hours per week). Unmarried, unemployed children 21 years of age or older qualify if they are dependent upon you by reason of a mental or physical disability and have been continuously so disabled since the age of 21. Unmarried, unemployed children who became totally disabled while attending an accredited educational institution, college, or university on a full-time basis prior to the age of 25 and have been continuously so disabled since that time also qualify as dependent(s). Dependent coverage begins for your eligible dependents on the same date as your coverage, or as soon as they become eligible dependents if added later, provided that dependent benefits were applied for within 31 days of their becoming eligible. If coverage for contributory benefits is not applied for within this 31 day period, evidence of health for the dependents may have to be submitted and approved before coverage begins.

GENERAL INFORMATION

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EVIDENCE OF HEALTH Proof of good health is not required if application is made within 31 days of first becoming eligible. If coverage for contributory benefits is not applied for within this 31 day period, evidence may be requested, at your own expense, for your dependents, if any, before benefits commence. Certain other situations may require the submission of evidence of health before coverage will be approved. These could include benefits in excess of the non-evidence limits, as indicated in the Schedule of Benefits, and late reporting of salary changes where benefits are related to earnings. The cost of obtaining evidence of health shall be paid by Saskatchewan Blue Cross if you or your dependents apply for coverage within 31 days of becoming eligible. ACCESS TO INFORMATION For insured benefits, where provided for in applicable legislation, you are allowed to obtain copies of the following documents: - Your enrolment form or application for insurance; - Any written statement or other record, not otherwise part of the application provided to the insurer as evidence of

insurability; - With reasonable notice, a copy of the contract for insured benefits. The first copy will be provided at no cost to

you. A fee may be charged for subsequent copies. All requests for copies of documents should be directed to Saskatchewan Blue Cross at 1.800.667.6853.

CO-ORDINATION OF BENEFITS You and your family may also be covered through another plan for Extended Health Care benefits and/or Dental benefits. Generally, when you and your spouse have separate coverage, you should submit your claims to this plan first, then to your spouse's. Claims incurred by your spouse should be submitted to his/her plan first, and then to this plan. Claims for children covered under two plans should initially be submitted to the plan of the spouse with the earlier birthdate in a calendar year. In any case, no more than 100% of the cost of eligible services or supplies is reimbursed. LIMITATION PERIOD FOR LEGAL ACTIONS Every action or proceeding against an insurer (i.e. the Company) for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act. TERMINATION OF HEALTH AND DENTAL BENEFITS Coverage for Health and Dental benefits, if applicable, for you and your dependents will cease on the earliest of: - the date you terminate employment, - the date you cease to be eligible due to retirement, death, leave of absence, age limitation, change in

classification, etc., or - the termination date of the Group Contract. In the event of your death, coverage for eligible dependents will continue for Health and Dental benefits, if applicable, for a period of one year without payment of premiums until the earliest of: - the date similar coverage is obtained elsewhere, - the date which is 12 months from the insured’s death, or - the termination date of the Group Contract. (The exact terms and conditions are contained in the Group Contract) TERMINATION OF LIFE INSURANCE Coverage for you and your dependents will cease on the earliest of: - the date you terminate employment, - the date you cease to be eligible due to death, leave of absence, age limitation, change in classification, etc., or - the termination date of the Group Contract. (The exact terms and conditions are contained in the Group Contract)

GENERAL INFORMATION

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CLAIMING BENEFITS If your Group Plan contains the appropriate benefit, the following procedures should be followed in the event of a claim: 1. If your plan includes Group Life Insurance or Dependent Life Insurance, please obtain the necessary forms from

your employer. Certain portions must be completed by the employer, the claimant and/or the attending physician. Once the claim forms are completed, they should be submitted to Saskatchewan Blue Cross for processing. Written notice of claim must be given to Saskatchewan Blue Cross as soon as reasonably possible after the loss, and in no event later than one year from the date of the loss. Claims for disability benefits should be reported as soon as reasonably possible, but must be reported within 90 days immediately following the end of the elimination period.

2. All claims for Health and Dental Benefits, if applicable, must be submitted within twelve months of receiving the

services or supplies. To claim benefits, please follow the procedures described below. The participant must obtain an official receipt and submit this, along with a completed Group Extended Health

Benefits and/or Dental claim form, to Saskatchewan Blue Cross for payment. The appropriate claim forms are available from your employer or Saskatchewan Blue Cross. 3. If your plan includes Group Travel Benefits, an Emergency Out of Province claim form must be completed and

submitted along with statements or receipts outlining the services received. Claim forms may be requested by contacting Saskatchewan Blue Cross.

All hospital/medical accounts must first be assessed by the provincial government health plan. Reimbursement will be made by Saskatchewan Blue Cross directly to the insured upon receipt and appraisal of

the necessary information. Payment is made in Canadian currency based on the rate of exchange in effect at the conclusion of services, as determined by Saskatchewan Blue Cross' chartered bank.

ALL CLAIM FORMS SHOULD BE FORWARDED TO:

SASKATCHEWAN BLUE CROSS SASKATCHEWAN BLUE CROSS 516 - 2ND AVE. N. 100 - 1870 ALBERT ST PO BOX 4030 OR REGINA, SK S4P 4B7 SASKATOON, SK S7K 3T2 Telephone: 1.306.244.1192 Telephone: 1.306.525.5025 Fax: 1.306.652.5751 Fax: 1.306.525.2124

Claim forms are also available via the internet - www.sk.bluecross.ca

PRIVACY POLICY

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Saskatchewan Blue Cross has always been, and will continue to be, committed to protecting your privacy and ensuring your personal information remains confidential. We ensure compliance by our staff with the strictest standards of security and confidentiality. Protecting your privacy and the confidentiality of your personal information is fundamental to the way we do business. COLLECTION In the process of our doing business with you it is often required to collect personal information. We do not collect this personal information unless it is provided to us voluntarily and knowingly through written, verbal, or electronic contact with you. In some cases we may be required to obtain information from third parties. When you apply for coverage with us, we require that a consent be completed providing us with your authorization to collect the information required to carry out the terms of your policy. USE When requesting information we will only request data necessary and appropriate under the circumstances. Your personal information will not be provided to any third parties other than those authorized by you. Information collected will be maintained to assist us in understanding and appropriately responding to your current and future needs. It may be utilized for planning benefit enhancements and sound financial management. We do not use or disclose your personal information for purposes other than those for which it was collected, unless we obtain your future consent. CHANGING INFORMATION At any time you may advise us of changes in the personal information we have in your file so your information may be updated. PROTECTION & DISCLOSURE Your information will not be shared with anyone outside Saskatchewan Blue Cross except when required or permitted by law or with your express or implied consent. We protect your personal information with appropriate security measures, and those third parties who receive the documentation are required to do the same. Information collected is provided only to individuals who are required to provide service respecting your policy. They are provided only with the necessary information to perform their duties. Personal information is only provided to identifiable individuals who are of legal age. If you do not agree with the proposed use or disclosure of your personal information, you may withdraw your consent at any time, subject to legal or contractual restrictions, and reasonable notice. Your withdrawal may prevent us from offering our products or services to you. Employees who have access to your information comply with the privacy principles as well as the company’s Code of Conduct (Ethics) which requires employees to uphold strict standards of confidentiality regarding the affairs and accounts of subscribers. Your personal information should be as accurate, complete and up-to-date as possible in order to minimize the possibility that inappropriate information will be used in making a decision respecting your coverage. This requires that information be updated on a reasonable basis. Information is only updated to the extent that is necessary for the purpose for which it was collected. At your request, we will confirm the personal information we hold about you, what it is being used for and to whom it is being disclosed. When making such requests, you will be asked to identify yourself and must be specific about the type of information you are requesting that may be in our control. Where possible, we will give you access to your information and you may review its accuracy and completeness. In limited situations, we may not be able to provide you with access to the information; for example, where it may be too costly to retrieve the information or where the information cannot be disclosed for legal, security or commercial proprietary reasons. When information is not easily accessible, we may charge a reasonable retrieval fee.

PRIVACY POLICY

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We have developed policies and procedures which dictate how long we will keep your personal information. These policies and procedures ensure that we destroy, erase or make anonymous your personal information when it is no longer needed to fulfil the purposes identified. Reviews on privacy will be conducted on a regular basis to ensure you are properly protected and respected. We protect your personal information from loss or theft, and from unauthorized access, disclosure, copying, use or modification. The type of safeguard depends on the sensitivity of the information and all paper information is shredded when destroyed. We hold ourselves accountable for the personal information we have about you. In order to achieve this objective, we have assigned an individual in our organization to ensure that Saskatchewan Blue Cross implements the policies and procedures necessary to comply with the principles outlined in this document. If you would like more details about your information and your privacy, or require changes to existing information, please contact us. We would be pleased to assist you and answer your questions or hear your concerns. If you have expressed concerns respecting the privacy of your information and your concerns have not been addressed to your satisfaction, please express your concerns (in writing) to our Chief Privacy Officer, who will ensure your concerns are addressed by the further enhancement of policies and procedures. TO CONTACT US By Phone: 1.800.667.6853 Monday – Friday, 8:30 a.m. - 5:00 p.m. If you are calling from in Saskatoon, please call 667.5200 By Fax: 1.306.652.5751 By E-mail: www.getinfo@sk.bluecross.ca By Mail: Saskatchewan Blue Cross PO Box 4030 Saskatoon SK S7K 3T2

EXTENDED HEALTH BENEFITS

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You (and your dependents, if applicable) are insured for the following health care benefits incurred during the diagnosis or treatment of an illness or accidental injury subject to any deductible, co-insurance, co-payment, or maximum shown in the Schedule of Benefits. Prescription Drugs: Drugs, including in-hospital drugs, are eligible when they have been: - prescribed by a physician or dentist (specific preventive medications which do not require a prescription such as

flu shots, allergy shots and vaccines are eligible for payment), - assigned a drug identification number in Canada, - dispensed by a licensed retail pharmacy or attending physician, and - are not normally available over the counter. Excluded are experimental drugs, fertility drugs, smoking cessation drugs, sexual dysfunction drugs, dietary aids, vitamins, Rogaine or any other product prescribed to restore hair growth, and any medication prescribed for cosmetic purposes. Preferred Accommodation: Semi-private or private, as indicated in the Schedule of Benefits. Charges for preferred in-hospital accommodation, when requested by the participant. Ambulance: Licensed road ambulance service to transport a patient to and from the nearest hospital able to provide essential care, including the expenses of an attendant (not a relative) when medically necessary. Air Ambulance: Licensed air ambulance to transport a patient to and from the nearest hospital able to provide essential care, including the expenses of an attendant (not a relative) when medically necessary. Private Duty Nursing: Services of a registered nurse (RN, RNA, or LPN) where the services have been ordered by the attending physician for an inpatient, as well as in the home of the participant (excluding services provided in nursing homes or for palliative care). Services provided by a nurse who ordinarily resides in the home or who is a member of the immediate family are excluded. The maximum allowable expense is $10,000 per person in a calendar year. Accidental Dental: Dental treatment or surgery required as a result of an accident to sound natural teeth but not when caused by an object wittingly or unwittingly placed in the mouth. Treatment must be rendered or reported and approved for payment by Saskatchewan Blue Cross within twelve months of the accident. Medical Equipment: Charges for rental of a wheelchair, hospital-type bed, patient walker and equipment for the administration of oxygen on the written authorization of a physician. If, due to extended illness or disability, it is felt that the need for these items will be long-term, Saskatchewan Blue Cross, at its discretion, may approve the purchase of these items. Prosthetic Appliances: Charges for artificial eyes, limbs, crutches, canes, splints, casts, trusses, rib belts, and cervical collars when prescribed by a physician. Replacement of the above items will not be covered unless replacement is required due to pathological change. Wigs required due to a medical condition and prescribed by a physician will be covered to a maximum of $500 per person in a calendar year. Braces: Charges for custom fitted braces, which incorporate a rigid support of metal or plastic, when prescribed by a physician. Replacement will not be covered unless replacement is required due to pathological change. (Excluded are dental braces and sports braces.) Breast Prosthesis: Charges for breast prosthesis following mastectomy, to a maximum of one per person every two calendar years (two if a double mastectomy) on the written order of a physician. This benefit also includes payment of surgical brassieres to a maximum of two per person per calendar year. Diabetic Supplies: Charges for the following diabetic supplies in a quantity prescribed by a physician and deemed reasonable by Saskatchewan Blue Cross; i.e. needles, syringes, swabs, test tapes and lancets. Diabetic Equipment: Charges for preci-jet, glucose meters or similar equipment used for the treatment and control of diabetes. Insulin pumps are excluded.

EXTENDED HEALTH BENEFITS

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Medical Supplies: Charges for surgical stockings, embolic stockings, stump socks and burn garments.

Ostomy Supplies: Charges for essential ostomy supplies when prescribed by a physician.

Hearing Aids: Charges for hearing aids (excluding batteries) up to $500 in five calendar years. Dependent children less than 21 years of age requiring a hearing aid for each ear are eligible for two hearing aids (one for each ear) to a maximum expense of $500 per child for each hearing aid in three calendar years.

Paramedical/Health Practitioners: Charges for diagnosis or treatment, except when performed in a hospital, by a licensed chiropodist/podiatrist, physiotherapist, chiropractor, osteopath, naturopath, acupuncturist, Christian Science Practitioner and registered massage therapist. The maximum allowable expense for each type of practitioner is indicated in the Schedule of Benefits.

Psychologists: Charges for diagnosis or treatment, except when performed in a hospital, by a licensed and registered psychologist. The maximum allowable expense is indicated in the Schedule of Benefits.

Speech Therapy: Charges for diagnosis or treatment, except when performed in a hospital, by a registered speech therapist. The maximum allowable expense is indicated in the Schedule of Benefits.

Orthopaedic Shoes: Purchase, repair, or replacement when necessitated by a physical change for custom-made orthopaedic shoes when prescribed by an orthopaedic surgeon, physiatrist, rheumatologist, or the attending physician. Stock item footwear are excluded. A limit of one pair of orthopaedic shoes per person every calendar year applies.

Foot Orthotics: Purchase, repair, or replacement when necessitated by a physical change for custom-made foot orthotics including scaphoid pads, torque heels, insoles, metatarsal pads, and molded arch supports when prescribed by an orthopaedic surgeon, physiatrist, rheumatologist, or the attending physician. Stock item footwear are excluded. The maximum allowable expense is $300 per person every calendar year. Aerochambers / Nebulizers / Continuous Positive Airway Pressure (C-PAP) Accessories: Charges for the purchase of aerochambers, nebulizers and continuous positive airway pressure accessories (including masks, tubing, etc.) when prescribed by a physician.

Mobility Aids: Charges for the purchase of bathroom rails, bath seats, raised toilet seats or reachers, on the written authorization of a physician.

Blood Pressure Monitors: Charges for the purchase or rental of a blood pressure monitor on the written authorization of a physician (limitation of the purchase of one blood pressure monitor every five calendar years).

Cardiac Rehabilitation: Charges for treatment rendered to cardiac patients under a recognized cardiac rehabilitation program where such treatments have been prescribed by the attending physician for:

- rehabilitation after myocardial infarction, coronary bypass surgery or valve replacement, or - the management of angina pectoris or other diagnosed cardiac disease.

Payment is limited to a lifetime maximum of $300 per person.

Eye Examinations: Charges for eye examinations, including eye refractions, performed by a licensed optometrist, or ophthalmologist for insured persons who live in a province where eye examinations are not covered by a provincial or government plan. Overall maximum of $75 per person in two calendar years applies (every calendar year for eligible dependent children under age 21).

Outside Province of Residence Referral Benefit: Charges for services outside of your province of residence recommended by a physician for treatment which is not available in your province of residence, to a lifetime maximum of $100,000. The claim must have prior approval from the provincial government and Saskatchewan Blue Cross.

Payment will not be made for diagnosis and/or treatment of any illness:

- commencing within 12 months of the effective date of group coverage, - for which medical treatment or prescribed drugs have been received 12 months prior to the effective date of this

coverage, - where the condition existed prior to the effective date of the group coverage, or - for experimental medical procedures or treatment methods not approved by the Canadian Medical Association.

EXTENDED HEALTH BENEFITS

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BENEFIT PERIOD Each benefit period covers one calendar year. ANY DEDUCTIBLE OR LIMITS APPLY ON A CALENDAR YEAR BASIS. CONVERSION OPTION If your coverage ceases because of termination of employment, you may apply within 31 days to convert to one of the programs available to individuals through your local Blue Cross at that time. In the event of loss of coverage due to a change in status, or your death, a spouse or dependent child may also apply within 31 days of the change to convert to one of the programs available to individuals through your local Blue Cross at that time. EXCLUSIONS AND LIMITATIONS Extended Health Care Benefits will not be payable for charges in connection with the following: - services or supplies normally provided without cost or at nominal cost by any government health plan, or any

plan or arrangement, - services or supplies covered by the Non-Insured Health Benefits program through the Medical Services Branch

of Canada, - services or supplies to which the participant is entitled under any Workers' Compensation statute or any other

legislation, - charges relating to elective services obtained outside the participant's province of residence when the provincial

government health care programs have not accepted liability for those items normally covered in the participant's province of residence,

- medical examinations or routine general checkups required for the use of a third party, - charges for rest cures, convalescent care, custodial care, or rehabilitation services, - services or supplies for cosmetic purposes or conditions not detrimental to one's health, - expenses incurred as a result of self-inflicted injuries; abuse of medications, drugs, or alcohol; or suicide or

attempted suicide, - expenses incurred as a result of active participation in an insurrection, war or act of war (declared or not), or the

hostile action of the armed forces of any country, service in the armed forces, hijacking, terrorism, or any riot, public confrontation, civil commotion, or any other act of aggression,

- expenses incurred as a result of committing or attempting to commit a criminal act, - charges for missed appointments or the completion of change forms, or - mileage or delivery charges.

OUTSIDE PROVINCE OF RESIDENCE TRAVEL BENEFITS

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In the event of an accident or unexpected illness occurring outside your province of residence, reasonable and customary charges will be paid for the following eligible expenses, subject to any co-insurance, limitation(s), or maximum amount shown in the Schedule of Benefits, or maximums specified below. Hospital Accommodation: Hospital accommodation in excess of the amount paid by the provincial government plan. Physicians & Surgeons: Services of a duly licensed physician when allowed by the provincial government plan. Prescription Drugs: Prescription drugs as prescribed by the attending physician and supplied by a pharmacist. Nursing Services: Special duty nursing charges when ordered by the attending physician following emergency services. Ambulance: Licensed ambulance service, including air ambulance to the nearest qualified medical facility, as follows: - Post Emergency Evacuation - Subject to medical advice to the contrary, evacuation of the patient, without

dependents, to a hospital in their province of residence, where pre-authorized by Saskatchewan Blue Cross. - Where pre-authorized by Saskatchewan Blue Cross, and upon written advice from either the attending physician

or a commercial airline that a patient must be accompanied by a qualified medical attendant, Saskatchewan Blue Cross shall pay the costs incurred for one direct round trip economy fare for the medical attendant.

Diagnostic: X-rays, examinations, and diagnostic laboratory procedures. Medical Appliances: The cost of casts, crutches, canes, slings, splints, trusses, braces and/or temporary rental of a wheelchair when required as a result of sickness or accident. This benefit will be payable only when the sickness or accident occurs outside the participant's province of residence and when ordered by a physician. Paramedical Services: Charges for diagnosis or treatment, except when performed in a hospital, by a licensed chiropodist/podiatrist, physiotherapist, chiropractor, osteopath, and naturopath. Accidental Dental: Charges for dental treatment when natural teeth have been damaged by a direct, accidental blow to the mouth or a fractured or dislocated jaw requiring setting. This dental treatment must be rendered or reported and approved for payment by Saskatchewan Blue Cross within six months of the accident. Eligible expenses will be the dentist's usual and customary fee according to the current Dental Fee Guide for general practitioners in effect where services are rendered. Meals & Accommodation: Up to $800 ($100 per day) for commercial accommodations and meals incurred by you or a covered family member travelling with you when your trip is delayed due to illness or accident. Vehicle Return: Up to $500 for the cost of returning your vehicle when you are unable due to illness or accident. Return of Deceased: The cost of transportation to return the deceased to your province of residence, excluding the cost of burial coffin or urn. Family Transportation Expense: Up to $1,000 for transportation cost in the event that an insured is hospitalized and the physician advises the attendance of a family member (next of kin). Worldwide Travel Assistance: The provision of 24 hour telephone and telex services around the world in the event of emergency medical situations requiring hospitalization; plus: - confirming coverage and payment to a doctor and/or hospital, - arrangement for medical evaluation by a qualified physician and then referral to a medical facility equipped to

provide treatment, - transfer of patient to another medical facility if required, - assistance in contacting the family or business partner, and - emergency response in any language.

OUTSIDE PROVINCE OF RESIDENCE TRAVEL BENEFITS

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CONVERSION OPTION If your coverage ceases because of termination of employment, you may apply within 31 days to convert to one of the programs available to individuals through your local Blue Cross at that time. In the event of loss of coverage due to a change in status, or your death, a spouse or dependent child may also apply within 31 days of the change to convert to one of the programs available to individuals through your local Blue Cross at that time. EXCLUSIONS AND LIMITATIONS Saskatchewan Blue Cross will not pay any benefit or accept any liability for claims relating to: - benefits payable by the participant's government health plan or any other government agency, - services or supplies covered by the Non-Insured Health Benefits program through the Medical Services Branch

of Canada, - referral treatment, - elective (non-emergency) treatment or surgery, - expenses incurred as a result of self-inflicted injuries; abuse of medications, drugs or alcohol; suicide or

attempted suicide; or committing or attempting to commit a criminal offense, - expenses incurred as a result of participation in an insurrection, war or act of war (declared or not), the hostile

action of the armed forces of any country, service in the armed forces, hijacking, terrorism, riot or public confrontation, civil commotion, or any other act of aggression,

- services or supplies not required for the immediate relief of acute pain or suffering which reasonably could have been delayed until returning to your province of residence,

- expenses associated with a pre-existing medical condition. A pre-existing medical condition means an illness or injury which is not stable prior to travel and/or has not been controlled by consistent treatment with prescribed medication prior to travel, and medical attention is not reasonably anticipated during the travel period. To be considered stable, a condition must not have required medical investigation, diagnosis, treatment, or hospitalization preceding the departure date,

- expenses associated with the required confinement of the participant due to childbirth and delivery if any portion of travel falls after the 32nd week of gestation,

- expenses incurred as the result of participation in professional sports or any speed contest, parachuting, bungee jumping, mountaineering, or spelunking, or

- expenses incurred as the result of a flight accident unless the participant is riding as a fare paying passenger on a commercial airline or charter aircraft with a seating capacity of six people or more.

VISION CARE BENEFITS

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Saskatchewan Blue Cross will pay the reasonable and customary charges for the following eligible expenses on a reimbursement plan basis. These benefits are subject to any deductible, co-insurance or maximum amount shown in the Schedule of Benefits, or the benefit maximums specified below. LENSES / FRAMES / CONTACT LENSES / LASER EYE SURGERY Charges for the following expenses: - corrective eyeglasses (lenses and/or frames) when prescribed by a licensed optometrist or ophthalmologist, - corrective contact lenses when prescribed by a licensed optometrist or ophthalmologist, and - laser refractive surgery when performed by a licensed ophthalmologist. The overall combined maximum amount, which applies to the above expenses, is indicated in the Schedule of Benefits. VISUAL TRAINING / REMEDIAL EYE EXERCISES Charges for visual training and remedial eye exercises up to a combined overall maximum lifetime eligible expense of $150. CONVERSION OPTION If your coverage ceases because of termination of employment, you may apply within 31 days to convert to one of the programs available to individuals through your local Blue Cross at that time. In the event of loss of coverage due to a change in status, or your death, a spouse or dependent child may also apply within 31 days of the change to convert to one of the programs available to individuals through your local Blue Cross at that time. EXCLUSIONS Vision Care Benefits are not payable for charges in connection with the following: - non-prescription sunglasses, - non-prescription safety glasses, or - any form of eyeglasses purchased for cosmetic or aesthetic purposes.

DENTAL BENEFITS

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Dental benefits are based on the usual and customary charges up to the Dental Fee Schedule as indicated in the Schedule of Benefits. The overall limits and co-insurance amounts are shown in the Schedule of Benefits. Procedures involving the use of gold if such treatment could not have been rendered at lower cost by means of a reasonable substitute consistent with generally accepted dental practice. If such treatment could have been rendered at lower cost by means of a reasonable substitute, only the expense that would have been incurred for treatment by means of the reasonable substitute shall be covered. Dental services in excess of $500 require pre-authorization by Saskatchewan Blue Cross, in writing in the form of a "Treatment Plan". Dental claim forms are provided for this purpose.

PREVENTIVE AND MINOR RESTORATIVE BENEFITS DIAGNOSTICS: Clinical Oral Examinations: - complete oral examination (one in a three calendar year period) - recall examination (two in a calendar year provided that a period of at least 5 consecutive months have elapsed

since the last such services was rendered) X-Ray Examinations: - full mouth or panoramic films (provided that a period of at least 24 consecutive months have elapsed since the

last series of x-rays was performed) - single films - cephalometric films (limited to five in two calendar years) - occlusal (limited to two in a calendar year) - Bitewing (limited to twice per calendar year provided that a period of at least 5 consecutive months have elapsed

since the last such service was rendered) - temporomandibular joint films Tests and Laboratory Examinations Diagnostic only. PREVENTIVE SERVICES: Polishing (limited to twice per calendar year provided that a period of at least 5 consecutive months have elapsed since the last such service was rendered), unlimited units of scaling; however, if more than 6 units of scaling/root planning are required in a 12 month period, we require a written estimate be submitted, fluoride treatments (two treatments in a calendar year provided that a period of at least 5 consecutive months have elapsed since the last such service was rendered), pit and fissure sealants, space maintainers, and protective athletic appliances (one appliance in a calendar year). RESTORATIVE SERVICES: Fillings, Composite inlays, onlays and cement restorations. ENDODONTIC SERVICES: Diagnosis and treatment of the pulp (nerve) of teeth, including root canal therapy. PERIODONTIC SERVICES: Diagnosis of the gums and bones which support the teeth. Maintenance, adjustments, repairs and relines of the temporomandibular joint (TMJ) diagnostic oral appliance. ADJUNCTIVE SERVICES: Office or Institutional visit. PROSTHODONTIC SERVICES: Denture adjustments and repairs, denture rebasing and relining (once in two calendar years), tissue conditioning, removal, repair and recementing fixed bridge. SURGICAL SERVICES: Extraction of teeth. MAJOR SURGICAL PROCEDURES: Surgical exposure of the tooth, surgical repositioning or transplantation, cutting of bone to aid in removal of teeth or to permit insertion of a denture, surgical shaping of gum tissue in order to support teeth, and tumors and cysts.

MAJOR BENEFITS

EXTENSIVE RESTORATIVES: Crowns and fixed bridges including inlays and onlays. (Single crowns and fixed bridges will be limited to once per tooth in a five year period.)

PROSTHODONTIC SERVICES: Complete dentures (limited to one upper and one lower in a five year period), partial dentures (limited to one upper and one lower in a five year period), single crowns and fixed bridges will also be limited to once per tooth in a five year period. MAJOR RESTORITIVE: Repairs to inlays, onlays and crowns. Recementation of inlays, onlays, crowns or veneers.

DENTAL BENEFITS

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ORTHODONTIC BENEFITS ORTHODONTIC SERVICES: Prevention or correction of irregularities of the natural teeth. BENEFITS FOR LATE APPLICANTS If application for dental benefits (employee or dependent) is made more than 31 days after the date on which the employee and/or dependent first becomes eligible, the maximum benefit will be limited to $100 per participant for Preventive and Minor Restorative Benefits and $100 combined for Major Restorative and Orthodontic Benefits during the first 12 months of coverage from the date of application. This provision does not apply to dental services required as a result of natural teeth being damaged by a direct accidental blow to the mouth after the effective date of the late applicant's coverage. CONVERSION OPTION If your coverage ceases because of termination of employment, you may apply within 31 days to convert to one of the programs available to individuals through your local Blue Cross at that time. In the event of loss of coverage due to a change in status, or your death, a spouse or dependent child may also apply within 31 days of the change to convert to one of the programs available to individuals through your local Blue Cross at that time. PREVENTIVE, MINOR AND MAJOR RESTORATIVE AND ORTHODONTIC DENTAL EXCLUSIONS AND LIMITATIONS Dental Care Benefits will not be payable for charges in connection with the following: - services or supplies normally provided without cost or at nominal cost by any government plan, or any plan or

arrangement, - services or supplies covered by the Non-Insured Health Benefits program through the Medical Services Branch

of Canada, - construction of an inlay, onlay, crown or fixed bridge unless there is extensive decay or breakdown which can not

be repaired by use of amalgam or similar restorative material, - replacement of lost or stolen prosthetic devices, - implants and/or services performed in conjunction with implants, - dental treatment required for cosmetic purposes or conditions not detrimental to one's health, - dental treatment required as a result of self-inflicted injuries; abuse of medications, drugs, or alcohol; or suicide

or attempted suicide, - expenses incurred as a result of active participation in an insurrection, war or act of war (declared or not), or the

hostile action of the armed forces of any country, service in the armed forces, hijacking, terrorism, or any riot, public confrontation, civil commotion, or any other act of aggression,

- expenses incurred as a result of committing or attempting to commit a criminal act, - services for which the government prohibits the payment of benefit, - services provided without charge or paid for by the employer, - services performed by an unqualified practitioner, - charges for missed appointments or the completion of claim forms, - any item or service not listed as a covered benefit, - experimental procedures, - oral hygiene instruction, - interproximal disking of teeth, - removal of inlays, onlays, crowns or veneers, - denture cleaning and polishing, - Temporomandibular joint (TMJ) intra-oral repositioning appliance, or - metal, ceramic, porcelain, ceramic polymer glass inlays and onlays.

BASIC AND OPTIONAL FAMILY GROUP LIFE BENEFIT

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DEATH BENEFIT The death benefit provides for payment of the amount shown in the Schedule of Benefits to your designated beneficiary. A special advance payment may be provided if you are suffering from a condition which is expected to result in death within 12 months of your request for such payment. The payment must be requested in writing and will be the lesser of $50,000 or 50% of your group Basic Life coverage. EMPLOYEE AND FAMILY OPTIONAL LIFE INSURANCE Optional Life Insurance benefits are payable to you, if living, otherwise to your designated beneficiary. WAIVER OF PREMIUM – OPTIONAL GROUP LIFE AND DEPENDENT OPTIONAL LIFE INSURANCE If you become totally disabled prior to your 65th birthday, and remain disabled for a period of four months, Optional Group Life and Dependent Optional Life Insurance coverage is continued without payment of premium from the first of the month following the date of disability, provided that proof of total and continuous disability is submitted as required. Saskatchewan Blue Cross defines total disability as a state of continuous incapacity, resulting from illness or injury, which wholly prevents you from performing the regular duties of any occupation for which you would earn 60% or more of your Pre-Disability Earnings and for which are reasonable qualified, or may so become, by training, education or experience. Regular duties are defined as those work related activities which are considered essential to the performance of your occupation and which proportionately take the majority of time to complete. The availability of such occupations, jobs or work will not be considered while assessing your disability. The loss of a professional or occupational license or certification does not, in itself, constitute disability. In the event you recover from a total disability and become disabled again due to the same or related cause, the second period of disability will be considered a continuation of the first disability; unless the periods of disability are separated by an interval of at least six months during which you returned to work on a permanent basis. If a period of total disability is considered to be a continuation of a previous total disability, then premiums will be waived without the application of another six months of total disability. EXTENSION OF INSURANCE In the event of your death within 31 days following termination of employment, the Group Life Insurance benefit will be paid to your designated beneficiary provided that any individual policy issued under the conversion privilege is surrendered.

BASIC AND OPTIONAL FAMILY GROUP LIFE BENEFIT

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CONVERSION PRIVILEGE If you terminate employment prior to your 65th birthday, you may convert to an individual policy issued by Saskatchewan Blue Cross, without evidence of insurability. Written application must be made and the required premium submitted during the 31 day period immediately following the date of termination. If your Optional Group Life Insurance coverage ceases on or before attaining age 65 because of retirement, termination of employment or termination of membership in a class of employees eligible for insurance under this plan, then you may purchase individual life insurance in an amount not to exceed the lesser of the total amount of Group Life Insurance and Optional Group Life Insurance for which you were covered in the group plan on the termination date, or $200,000. This conversion option also applies to scheduled reductions or termination of coverage which become effective at specified ages. If the life insurance on your eligible dependent under this benefit terminates on or before attaining 65 years of age because of: - your death, or - the termination of your Group Life Insurance for any reason which entitles you to convert this life insurance - divorce or legal separation from you, or - your dependent ceases to be an eligible dependent, then your eligible dependent may purchase individual life insurance policy from Saskatchewan Blue Cross in an amount not to exceed the amount of Optional Group Life insurance on your eligible dependent which terminated. LIMITATION OF COVERAGE In the event of the death of an insured person by suicide, while sane or insane, the payment to be made with respect to any amount of Optional Insurance, which has been in force less than two consecutive years during the insured person's lifetime, shall be limited to the return of premiums. This limitation is applicable to Optional Life Insurance on you and your spouse. TERMINATION OF INSURANCE All Group Life Insurance will terminate on the earliest of: - the date that you cease to be eligible for Group Life Insurance, - the date of termination of this coverage, - the day on which you attain the age limit specified in the Schedule of Benefits, or - the end of the grace period for which any premium has not been paid in full. - the date the dependent ceased to be an eligible dependent The Optional Group Life Insurance on your dependent will cease on the date the dependent ceases to be an eligible dependent or the termination ages shown in the Schedule of Benefits.

DEPENDENT LIFE INSURANCE BENEFIT

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DEATH BENEFIT The Dependent Life Insurance benefit, as indicated in the Schedule of Benefits, will be paid to you upon the death of an insured dependent. ELIGIBLE DEPENDENTS An eligible dependent is as defined under General Information. COMMENCEMENT OF INSURANCE Insurance on your dependent begins on the later of the date the application for dependent insurance was completed or the date you acquired the dependent, provided the dependent is not confined to a hospital. In this instance, coverage for the dependent will commence on the date the dependent ceases to be confined to hospital. In the case of a child born while this coverage is in force, the coverage on the child will be effective from their live birth, or in the case of a still birth, coverage on the child will be effective from 28 weeks gestation. EXCEPTIONS AND LIMITATIONS Dependents excluded from the policy include: - any spouse residing outside of Canada or the United States of America, or - any person for whom evidence of insurability, if required, is not approved by Saskatchewan Blue Cross. CONVERSION PRIVILEGE You may convert the insurance on the life of your spouse in the same manner as under the Group Life benefit in an amount not to exceed the amount of insurance which terminated. The Conversion Privilege is available to your spouse only -- not to dependent children. EXTENSION OF INSURANCE If your spouse should die within 31 days your termination of employment, your spouse’s death benefit will be paid, provided that any individual policy issued under the Conversion Privilege is surrendered.

NOTES

NOTES

® Saskatchewan Blue Cross, Blue Cross Life Insurance Company of Canada, BlueLink and Second Opinion are registered trade-marks of the Canadian Association of Blue Cross Plans, used under license by Medical Services Incorporated, an independent licensee.